CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Rock County Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $143
Cash Discount Price: $178
vs. Medicare Baseline: 1.50x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Rock County Hospital is $143. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $178. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.50x the Medicare baseline. Located in 102 East South Street, Bassett, NE.

Cash / Self-Pay

$178

Average discount available for prompt cash payment at this facility.

Insurance Median

$143

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$95.19

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $95.19 (100%)

Cash / Self-Pay: $178 (187%)

Insurance Median: $143 (150%)

Cash: $178 (187% of Medicare)

Ins. Median: $143 (150% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $95.19 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Blue Cross Blue Shield	$54 - $216	57%
Molina	$94 - $142	99%
Midlands Choice	$95	100%
Oscar	$95	100%
UnitedHealthcare	$132 - $200	139%
Nebraska Total Care	$134 - $203	141%
Integrated Health Plan	$142 - $214	149%
Interplan Health Group	$142 - $214	149%
Coventry Health Care	$143 - $216	150%
First Health	$143 - $216	150%
Medica	$143	150%
Mutually Preferred	$143 - $216	150%
Multiplan	$145 - $218	152%
Ppo Next	$145 - $218	152%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $178.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99213.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Rock County Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 99213.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.